US · guidance
CMS Pub. 100-04, ch. 30, § 240.4
Results of the QIO Review
If the QIO disagrees with the hospital’s determination and says the stay is reasonable
and necessary, the beneficiary will be refunded any amount collected except applicable
coinsurance and deductibles, and convenience items or services not covered by Medicare.
If the QIO agrees with the hospital determination and says the stay is not reasonable
and necessary, the beneficiary will be responsible for all services on the date specified by
the QIO.
History
(Rev. 1257, Issued: 05-25-07; Effective: 07-01-07; Implementation: 07-02-07)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
807d5b23eafba6e346420c226a97535d55f7f2151dbab0a8b54fa9f6425f551f
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.